Provider Demographics
NPI:1386030062
Name:DYNAKINETICS PT PC
Entity Type:Organization
Organization Name:DYNAKINETICS PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT ANDRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:VILLANUEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:917-645-3620
Mailing Address - Street 1:8431 VAN WYCK EXPY APT 3J
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2611
Mailing Address - Country:US
Mailing Address - Phone:917-645-3620
Mailing Address - Fax:
Practice Address - Street 1:11605 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-1749
Practice Address - Country:US
Practice Address - Phone:718-850-7100
Practice Address - Fax:718-850-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-09
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031185261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy